Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy With Midventricular Obstruction and Papillary Muscle Abnormalities

Although abnormal mitral valve complexes are frequently observed, alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) with an anomalous papillary muscle (PM) is challenging. We present the case of a 65-year-old woman with HOCM concomitant with midventricular obstruction and anomalous PMs. She was referred to our hospital for septal reduction therapy to alleviate recurrent syncope, chest pain, and heart failure symptoms. ASA was performed to ablate the left ventricular (LV) myocardium from the base to the middle via 6 septal branches. The pressure gradient in the LV outflow tract decreased considerably, and midventricular obstruction persisted immediately after ASA. There were no recurrent episodes of syncope or chest pain, and the heart failure-related symptoms improved. Eighteen months later, the LV outflow tract and midventricular obstructions were relieved. This case indicates that ASA is an alternative option to relieve symptoms, even if anomalous PMs and midventricular obstruction coexist in HOCM.